INSIDE THE ISSUE

> Surprise Billing Rules
> New Throughput Survey
> The Public Charge Rule
> HEALTH EQUITY: Transplants, Telehealth
> Tufts Medicine
> Fight MRSA
> PICCK Webinars

MONDAY REPORT

New Surprise Billing Rules Being Drafted to Conform to Law

Following the ruling from a U.S. District Court in Texas on February 23, the Biden Administration says it will scrap some of the regulations it drafted to implement the No Surprises Act, which protects patients from surprise bills and determines how to resolve provider-insurer payment disputes.

Patients continue to be protected as they always have been. At issue is the independent dispute resolution (IDR) process between providers and payers. The court said the federal departments of Health & Human Services, Treasury, and Labor that drafted the regulations circumvented Congress’s intent by placing too much emphasis on the “qualifying payment amount” – essentially an insurer-set median rate – when settling disputes through the IDR process. The court also found that the administration circumvented the Administrative Procedures Act by not allowing a full notice-and-comment process.

Last week, the administration sent notice that it heard the court’s message, was withdrawing the parts of the regulations at issue in the Texas case, and would redraft them to conform to the ruling. The administration will offer training on the new dispute resolution process and use the new regulations to settle all disputes, including ones in which the open negotiation period under the rules have already expired. Now there will be a reset of those cases using the new rules.

“Data Drives Solutions” – MHA’s New Throughput Survey

An ongoing problem, and one exacerbated by the pandemic, is the throughput of patients from acute care hospitals to post-acute care. Staffed bed shortages, the COVID status of patients and the ability of facilities to handle them, as well as transportation issues among other factors all conspire to make moving patients from one care setting to another difficult.

To gather pertinent granular data on the characteristics of these patients and to assist in the formulation of a solution to the challenge, MHA today launched a monthly patient throughput survey. MHA will send the online survey to every hospital in the commonwealth on the first Monday of each month before 5 p.m. and will ask for responses by 5 p.m. Friday of that same week. The survey asks, among other data points, the number of patients awaiting discharge to skilled nursing facilities, long-term acute care hospital/inpatient rehabilitation facilities, and home health services; the length of time that patients have been awaiting discharge; vaccination barriers to discharge; and more. The survey also includes questions relating to patient demographics to assist in MHA’s ongoing health equity efforts.

“We know that data drives solutions,” said MHA’s V.P. of Clinical Affairs Patricia Noga, R.N. “MHA and Mass. Senior Care, through our Post- Acute Care Transitions Collaborative, are addressing the backlog of hospital patients who require post-acute care but who have not been able to find placement, thereby leaving them in hospitals for weeks, if not months. Our new throughput survey is yet another tool to help us resolve this pressing issue.”

An Update on the Public Charge Rule

The Trump Administration’s expansion of the public charge rule was thought to be dead one year ago in March 2021, when the new Biden Administration signaled it would not defend the rule against the many lawsuits brought against it. And just last month, the Biden Administration published a proposed new public charge rule that removes the contentious elements that the previous administration had inserted into the rule.

Meanwhile, the U.S. Supreme Court heard a challenge to the Biden Administration’s actions that ultimately will not change the specifics of the public charge rule, but could change the procedures administrations take in issuing and revoking such rules.

At issue is the previous administration’s expansion of the criteria used to determine whether to approve certain immigrants seeking to live legally in the U.S. or to obtain legal status through a green card. The Trump administration added use of Medicaid and Supplemental Nutrition Assistance Program (SNAP) to the list of programs that could disqualify an immigrant seeking status change. MHA, the Baker Administration, patient advocates, and a wide range of others interests throughout the U.S. strongly opposed adding Medicaid and SNAP to the charge rule. The fear was that immigrants would avoid seeking care and healthcare coverage – even care they are entitled to – due to the fear of having their immigration status revoked by an aggressive federal government. Avoiding care leads to worsening care and concurrent rising healthcare costs.

President Biden campaigned against the rule’s expansion and directed his Department of Justice (DOJ) not to defend it. A group of “Red” states then brought suit, arguing that if DOJ wouldn’t defend the Trump-era rule, they would. They also argued that rescinding a rule by simply neglecting it in the courts illegally circumvents the Administrative Procedure Act. The Supreme Court case that was heard on February 23 focuses on such finely wrought questions of whether states can litigate a federal case brought in another state’s court and whether the “end around” to bypass the Administrative Procedure Act is legitimate. A decision is expected by June.

The next day, on February 24, the Biden Administration’s Department of Homeland Security published a proposed new public charge rule that deletes the Medicaid and SNAP references. Parties have until April 25, 2022, to comment on the proposal.

National Academies Finds Inequities in Organ Transplants

A congressionally mandated National Academies of Sciences (NAS) study of organ donations found inequities in what groups get transplants, meaning that “an individual’s chance of referral for transplant evaluation, being added to the waiting list, and receiving a transplant varies greatly based on race and ethnicity, gender, geographic location, socioeconomic status, disability status, and immigration status.”

The NAS found that there were 41,354 transplants performed in 2021, which was nearly 6% more than in the previous year, despite the complications of the COVID-19 pandemic. However, the study found that the organ donation system is “demonstrably inequitable,” with minority and underserved populations disadvantaged in accessing transplant services and experiencing worse outcomes when they eventually receive an organ.

The NAS study found that in the United States there are a large number of donated organs that are never transplanted – a fact that NAS termed “startling.” The study said that patients are often left out of the decision-making process on whether to accept or decline a donated organ, and that system needs to be more transparent and accountable.

“Because many individuals from minority and underserved populations, as well as women, are never added to the waiting list, bringing these individuals into the system, combined with improved fairness in the allocation policies that govern how patients are prioritized on the waiting list, would help create a more equitable system,” the NAS wrote. The academy laid out strategies for changing the entire organ donation and transplant system within five years.

Spanning the Digital Divide

The benefits of telemedicine have been demonstrated clearly during the pandemic, leading to a sea change in how care is delivered. To enjoy the benefits of telemedicine, people need to have good access to the internet. Yet many lower income individuals lack the ability to pay for ever-increasing technology costs.

However, the Affordable Connectivity Program (ACP) of the Federal Communications Commission helps low-income households pay for internet services and connected devices. The ACO replaced the Emergency Broadband Benefit (EBB) program and is eligible to more than 10% of Massachusetts households.

On Thursday, March 17 from 10 to 11 a.m., the Massachusetts Law Reform Institute is hosting an informational session entitled “The ABCs of the ACP.” The zoom session can assist hospital personnel in their ongoing efforts to help households within their service areas span the digital divide. Register here.

Wellforce is Now Tufts Medicine

Sign Up for Free Program to Combat MRSA

Hospitals may register for a free Agency for Healthcare Research and Quality (AHRQ) safety program aimed at preventing methicillin-resistant staphylococcus aureus (MRSA). Johns Hopkins Medicine and NORC at the University of Chicago are leading the AHRQ program, which hopes to recruit at least 400 ICUs and 400 non-ICUs across the country. The 18-month program is slated to start in April 2022, and will provide hospitals with technical assistance, coaching, webinars, and tools to support their infection prevention programs. A brief program flyer is here, and the program website is here.

PICCK Updates its Webinar Offerings

PICCK (Partners in Contraceptive Choice and Knowledge) has announced it is postponing its Tools for Patient-Centered Contraceptive Counseling webinar from June to September 29. In its place, PICCK will hold a live webinar on Thursday, June 23, from noon to 1 p.m., entitled, Bleeding and Contraception: Friends or Foes. Visit here to register and to learn about other PICCK webinar offerings.

PICCK is a five-year program funded by the Executive Office of Health and Human Services and housed at Boston Medical Center/Boston University School of Medicine. MHA is a PICCK partner and MHA’s V.P., Clinical Affairs, Patricia Noga, R.N., sits on its advisory committee.

John LoDico, Editor